Free Press Staff Writer

About Michigan’s version of Medicaid

The Healthy Michigan plan urges cost-sharing by recipients. Here are details: ■ Nearly every participant has certain co-pays — $2 for visits to doctors or urgent-care clinics, for example. ■ Enrollees don’t pay the co-pays for the first six months. Rather, how much they go to health providers in that time will be tracked to determine monthly contributions to a health savings account starting in the seventh month. That contribution will be reassessed every six months. ■ Enrollees who make between 100% to 133% of the federal poverty level must contribute up to 2% of their income to the health savings account, which will be administered by the state and can be used for out-of-pocket expenses. The exact portion is based on the person’s or household’s modified adjusted gross income, or MAGI, as well as co-pays the enrollee would experience in the first six month of the program. ■ ost sharing — both the contributions to the health savings account and any co-pays — would not exceed 5% of the enrollee’s MAGI for the first four years and may increase after that to 7% for individuals who are deemed not medically frail. ■ Current Medicaid beneficiaries on the Adult Benefit Waiver program, a Medicaid program covering a limited number of Michigan adults, will be moved into the Healthy Michigan plan and subject to the same cost-sharing.

Understanding eligibility for Healthy Michigan

Eligibility for Medicaid is based on modified adjusted gross income (MAGI). For many consumers, this total is the same as their adjusted gross income (AGI) and is determined with your taxes each year. However, there are a few differences between AGI and MAGI. To determined whether your incomes are the same, here are the steps. (For more information, go to http://laborcenter.berkeley.edu and search for “modified adjusted gross income.”) Step 1

For Medicaid eligibility, exclude the following: ■ Scholarships, awards or fellowship grants used for education purposes and not for living expenses ■ Certain American Indian and Alaska Native income available to you because you are a member of this group. Casino payments or special student assistance are examples. ■ An amount received as a lump sum is counted as income only in the month received. For example, if you receive an inheritance or a job bonus in February, it is not counted if you apply for Medicaid in the summer. Source: The Center for Labor Research and Education at University of California at Berkeley

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Michigan’s long-awaited new Medicaid program — one that may extend health care coverage to 470,000 people — will open as planned at 12:01 a.m. April 1, despite bureaucratic and technical frustrations that had left thousands wondering whether the promise of the 2010 Affordable Care Act had left them behind.

Expecting a heavy first burst of applications, offices for the Michigan Department of Human Services will extend hours during the first days and phone lines will open from 8 a.m. to midnight to accept applications to the program, called Healthy Michigan.

A call center phone numbers will be released in the coming days, according to a department spokeswoman.

And the portal — www.michigan.gov/healthymichiganplan — has been repeatedly tested over several weeks to avoid a technical debacle like that last year of www.healthcare.gov, the federal health care reform web site now well-known for technical glitches that rendered it essentially useless for weeks.

“I’m optimistic we’re a go,” James Havemen, director of the Michigan Department of Community Health said this morning.

“We’re committed to when people come in they’re not going to be disappointed,” he said.

If all goes well, eligibility will be determined within minutes, even seconds. Coverage, too, will be nearly immediate — a sharp change from applications that are accepted under current Medicaid program and may take months to process.

The program is possible under the 2010 Affordable Care Act, which allows states to expand Medicaid to those whose incomes fall under 133% of poverty level. The 133% income level for an individual is $15,521; for a family of four, it is $31,721.

As it stands now, Medicaid in Michigan covers mostly children, disabled people and very poor people. The new plan extends coverage, in large part, to uninsured adults. It’s a managed-care system and consumers will choose plans they think are best for them.

Within 60 days of applying, by law, they will have a doctor’s appointment for a preliminary health screening, Havemen said.

Unlike Medicaid programs already in place in many other states, Healthy Michigan requires cost-sharing such as copays and contributions to health savings accounts. Those costs will be based on several things, including income and how often a consumer uses the health system.

However, coverage and care can’t be denied to someone who doesn’t contribute — something that supporters say insures easy access to care and Gov. Rick Snyder said isn’t an issue.

“Most people want to do the right thing,” said the Republican governor, who had pushed for Medicaid expansion, putting him at odds with many lawmakers in his party. “So let’s assume things are going to work well. We’ll run into issues like any other launch of anything new. ... These kinds of concerns would not be a reason not to do it.”

Haveman said the department will develop penalties later this year for nonpayment, like limiting a consumer’s provider network.

The program also rewards consumers for healthy behaviors. Giving up tobacco or getting blood pressure under control might reduce cost-sharing for a consumer, for example, Haveman said.

Twenty-five other states that decided to expand Medicaid did so on Jan. 1. But in Michigan, lawmakers approved the expansion only after a bitter political battle and without giving it immediate effect.

That meant a delay until this spring as the state worked out final federal approval and technical issues.

Haveman told the Free Press in February he wasn’t going to make any promises until the state was sure it was ready to “throw the switch.”

In recent weeks, the health department has begun contacting consumers that had applied on www.healthcare.gov, telling them they are eligible for Healthy Michigan. Moreover, they’ve begun to transfer about 60,000 consumers currently in a very narrow Medicaid category, called the Adult Benefits Waiver, to Healthy Michigan – a task that Haveman said should be nearly finished by April 1.

That category offers limited care to the poorest Michigan adults.

Contact Robin Erb at rerb@freepress.com or at 313-222-2708. Follow her on Twitter @Freephealth.